| Part Ⅰ Application of Superb Microvascular Imaging in differential diagnosis of benign and malignant prostate nodulesObjectiveTo explore the application value of Superb Microvascular Imaging(SMI)technology in the identification of benign and malignant tumors by detecting and grading the tiny blood flow in the prostate nodule.MethodsRetrospective analysis of our hospital from June 2019 to June 2021,a total of 65 suspicious nodules in 52 patients who planned to undergo prostate puncture detected by transrectal ultrasound were examined by SMI and contrast-enhanced ultrasound(CEUS).and the blood flow in the nodules were graded to determine the diagnosis of their benign and malignant respectively.The consistency of detection and grading of SMI and CEUS on the tiny blood flow in prostate nodules is compared,and the efficacy of the two methods in the diagnosis of prostate cancer(PCa)was evaluated based on the biopsy pathological results as the gold standard.ResultsThe Kappa value of SMI and CEUS in the detection and grading consistency test of tiny blood flow in prostate nodules was 0.76.P=0.000、P<0.01.The final pathological results showed that of the 65 nodules,27 were malignant(clinically significant prostate cancer in 26 cases,non-significant prostate cancer in 1 case)and 38 were benign.The diagnostic sensitivity,specificity and accuracy of SMI for prostate nodules were 74.07%(20/27),73.68%(28/38)and 73.85%(48/65)respectively.The diagnostic sensitivity,specificity and accuracy of CEUS were 85.19%(23/27),81.58%(31/38)and 83.08%(54/65)respectively.There was no significant statistical difference in diagnostic sensitivity,specificity and accuracy between the two methods(χ2=1.027、P=0.311,χ2=0.682、P=0.409,χ2=1.731、P=0.188).ConclusionThe detection and grading of tiny blood flow in benign and malignant prostate nodules and the diagnostic efficacy of the nodules by SMI are in good consistency with CEUS examination,which can be used to assist in the differential diagnosis of benign and malignant prostate nodules.Part Ⅱ Application value of transrectal ultrasound system puncture combined with Superb Microvascular Imaging technique targeted puncture in puncture biopsy of prostate cancerObjectiveTo investigate the application value of transrectal ultrasound system puncture combined with superb microvascular imaging(SMI)technique targeted puncture in the puncture biopsy of suspected prostate cancer(PCa).MethodsA total of 150 patients who were clinically diagnosed with suspected PCa from June 2021 to February 2023.but no obvious suspected malignant prostate lesions were found in routine grayscale ultrasound images,were retrospectively collected.The patients were divided into three groups according to the different ultrasound guidance techniques used for puncture biopsy:52 cases in the transrectal ultrasonography(TRUS)guided systematic puncture biopsy combined with SMI targeted puncture biopsy group.54 cases in the TRUS-guided systematic puncture biopsy combined with contrast-enhance ultrasound(CEUS)targeted puncture biopsy group,and 44 cases in the pure TRUS-guided systematic puncture biopsy group.The results of surgical pathology or clinical treatment and follow-up for at least six months were used as the gold standard to evaluate the diagnostic efficacy of percutaneous puncture biopsy guided by three ultrasound techniques for PCa.ResultsAmong the 52 patients in TRUS combined with SMI group,15 patients were pathologically diagnosed as PCa by puncture biopsy,according to the gold standard of diagnosis,16 patients were finally diagnosed with PCa,and the actual incidence of PCa was 30.77%(16/52)in this group.Among the 54 patients in the TRUS combined with CEUS group.13 patients were pathologically diagnosed as PCa by puncture biopsy,14 patients were finally diagnosed with PCa based on the gold standard of diagnosis,the actual incidence of PCa was 25.93%(14/54)in the group.There were 44 patients undergoing systematic puncture biopsy only under TRUS guidance,and just 7 patients were pathologically diagnosed as PCa by puncture biopsy,however,13 patients were finally diagnosed with PCa based on the gold standard of diagnosis,and the actual incidence of PCa was 29.55%(13/44)in this group.There was no significant difference in the actual incidence of PCa among the three groups(χ2=0.327,P=0.849、P>0.05).In the TRUS-combined SMI group,the TRUS-combined CEUS group and the pure TRUS group,the percentage of positive puncture needles in malignant tissue specimens obtained by puncture were 12.83%(72/561).11.58%(68/587)and 5.23%(23/440).respectively.The differences were statistically significant(χ2=17.253,P=0.000、P<0.05).there was no significant difference between the TRUS-combined SMI group and the TRUS-combined CEUS group,but there were statistical differences between the TRUS-combined SMI group or the TRUS-combined CEUS group and the pure TRUS group.The specificity of puncture biopsy in all three groups was 100%(that is,no false positive cases occurred).The diagnostic accuracy of puncture biopsy in TRUS combined with SMI group,TRUS combined with CEUS group and the pure TRUS group were 98.08%(51/52).98.15%(53/54)and 86.36%(38/44),respectively,and the differences were statistically significant(comparison of Fisher’s exact probability test,P=0.018.P<0.05).the differences between the TRUS-combined SMI group or the TRUS-combined CEUS group and the pure TRUS group were statistically significant.while the difference between the TRUS-combined SMI group and the TRUS-combined CEUS group was not statistically significant.The diagnostic sensitivity of biopsy in TRUS combined with SMI group,TRUS combined with CEUS group and he pure TRUS group were 93.75%(15/16),92.86%(13/14)and 53.85%(7/13),respectively.and the differences were statistically significant(comparison of Fisher’s exact probability test,P=0.013,P<0.05),the differences between the TRUS-combined SMI group or the TRUS-combined CEUS group and the pure TRUS group were statistically significant,while the difference between the TRUS-combined SMI group and the TRUS-combined CEUS group was not statistically significant.ConclusionThe diagnostic sensitivity and accuracy of TRUS guided system puncture biopsy combined with SMI targeted puncture biopsy for PCa are higher than that of the current clinical routine TRUS guided system puncture biopsy,and the diagnostic efficacy of TRUS guided system puncture biopsy combined with SMI targeted puncture biopsy was consistent with that of TRUS system puncture biopsy combined with CEUS targeted puncture biopsy for PCa.SMI technology is simple in operation and comprehensive in scanning examination,and can detect suspicious cancer nodules that are difficult to be found by conventional TRUS.Therefore,targeted puncture biopsy of suspected cancer nodules can be carried out to improve the diagnostic accuracy of ultrasound-guided puncture biopsy for PCa,which is expected to be further promoted and applied in clinical practice. |
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